What happens after Tymlos?

Katwhisperer, I'm definitely not an advocate for Prolia. I had one injection, joined this support group, learned more about it, and refused to continue the treatment. On Prolia, I had side-effects---back pain, and significant hair loss. I have no intention of taking it again unless my hip were to lose a lot more BMD, then I'd have to weigh the risks vs the benefits.
I've just started Evenity instead. I think there are a lot of doctors who don't understand how Prolia works but are a bit free and easy about prescribing it. I continue learning, and now know that it can be used safely for short periods and actually improves bone quality a little bit. The most impressive thing about it is that it increases BMD at the hip by 5-6% with just 3-4 treatments. Evenity is the only other OP drug that can do that. I got this information from an interview of Dr. McCormick. I took extensive notes, so I'm confident that I'm passing on the information as he presented it.
For some people, Prolia is a good option if used correctly and followed with a bisphosphonate (Dr. McCormick recommends Reclast). The key is finding a doctor who knows when and how to use it.

Plan to share my med info as I continue Tymlos until Aug 2024.

If anybody is interested, below are DEXA results showing 6 yr trend:

AP Spine (L1-L4) Statistically significant increase from previous scan.
07/27/2023 78 1.104 0.5 0.150 (15.7%)* 0.058 (5.6%)*
01/13/2022 76 1.046 0.0 0.092 (9.6%)* 0.032 (3.2%)*
12/01/2017 72 1.013 -0.3 0.060 (6.3%)* 0.060 (6.2%)*
10/02/2008 63 0.954 -0.8
*Denotes significance at 95% confidence level, LSC is 0.022326 g/cm2
------------------------------------------------------------------------

Total Hip(Left) Statistically significant increase from previous scan.
07/27/2023 78 0.800 -1.2 0.041 (5.4%)* 0.030 (3.9%)*
01/13/2022 76 0.770 -1.4 0.011 (1.4%) 0.013 (1.8%)
12/01/2017 72 0.757 -1.5 -0.002 (-0.3%) -0.002 (-0.3%)
10/02/2008 63 0.759 -1.5
*Denotes significance at 95% confidence level, LSC is 0.026675 g/cm2
------------------------------------------------------------------------

Femoral Neck(Left) Statistically no significant change from previous scan.
07/27/2023 78 0.607 -2.2 -0.008 (-1.3%) 0.008 (1.3%)
01/13/2022 76 0.599 -2.3 -0.016 (-2.6%) 0.011 (1.9%)
12/01/2017 72 0.588 -2.4 -0.027 (-4.4%) -0.027 (-4.4%)
10/02/2008 63 0.615 -2.1
*Denotes significance at 95% confidence level, LSC is 0.028808 g/cm2

Prolia is certainly impressive if you ignore the side effects and the potentially devastating rebound fractures that happen to some. I think Dr. McCormick offers a strategy of
1. a bone building med,
2. short term Prolia (2-4 doses),
3. following the Prolia with Reclast.
All the while following bone markers in order to avoid a sudden increase in bone breakdown if and when you stop the Prolia. And he warns if you go beyond about 3 doses (if my memory is correct) you have more risk of getting the rebound effect.
I'm thinking about this but it sure makes life more complicated and Prolia's rebound effect is just plain scary to me even with the strategy of following Prolia with Reclast.

Here's an interesting paper comparing Prolia to all the bio-phosphonates. It has charts showing the bone density changes year by year for each where the info is available. Prolia keeps increasing density for 8 years in some studies but there is a drop off at some bone sites around 3 years. The bio-phosphonates usually stop improving your bone after 2 years. All this shown in charts. So, Prolia totally wins in the bone gains department. But the paper doesn't do a through job on the negatives.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426099/

Prolia is certainly impressive if you ignore the side effects and the potentially devastating rebound fractures that happen to some. I think Dr. McCormick offers a strategy of
1. a bone building med,
2. short term Prolia (2-4 doses),
3. following the Prolia with Reclast.
All the while following bone markers in order to avoid a sudden increase in bone breakdown if and when you stop the Prolia. And he warns if you go beyond about 3 doses (if my memory is correct) you have more risk of getting the rebound effect.
I'm thinking about this but it sure makes life more complicated and Prolia's rebound effect is just plain scary to me even with the strategy of following Prolia with Reclast.

Here's an interesting paper comparing Prolia to all the bio-phosphonates. It has charts showing the bone density changes year by year for each where the info is available. Prolia keeps increasing density for 8 years in some studies but there is a drop off at some bone sites around 3 years. The bio-phosphonates usually stop improving your bone after 2 years. All this shown in charts. So, Prolia totally wins in the bone gains department. But the paper doesn't do a through job on the negatives.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426099/

Katwhisperer, I'm definitely not an advocate for Prolia. I had one injection, joined this support group, learned more about it, and refused to continue the treatment. On Prolia, I had side-effects---back pain, and significant hair loss. I have no intention of taking it again unless my hip were to lose a lot more BMD, then I'd have to weigh the risks vs the benefits.
I've just started Evenity instead. I think there are a lot of doctors who don't understand how Prolia works but are a bit free and easy about prescribing it. I continue learning, and now know that it can be used safely for short periods and actually improves bone quality a little bit. The most impressive thing about it is that it increases BMD at the hip by 5-6% with just 3-4 treatments. Evenity is the only other OP drug that can do that. I got this information from an interview of Dr. McCormick. I took extensive notes, so I'm confident that I'm passing on the information as he presented it.
For some people, Prolia is a good option if used correctly and followed with a bisphosphonate (Dr. McCormick recommends Reclast). The key is finding a doctor who knows when and how to use it.

Not surprising that the paper is filled with positives about Prolia while neglecting to mention much about the negatives.

Under the "Conflict of Interest Statement" section:
"OT has received fees from Amgen, GSK, Lilly, Nycomed, MEDA and Takeda as lecturer, consultant and/or scientific advisor."

Also, the report is from 2015 when many of the studies on the rebound effect were not out yet

My rheumatologist who I see for autoimmune disease as well as osteoporosis has said Prolia is only option. However I recently consulted with an endocrinologist who said that her recommendation is Reclast. She also said that, if I desire, she would manage my OP. I have decided to change from rheumatologist to endocrinologist for management as I don’t want to be on Prolia the rest of my life. Also I had 2 unusual osteoporotic fractures while on Prolia.

I just started Tymlos. My doctor, who specializes in osteoporosis, says we'll do a dexa at 18 months. Maximum 2 years on Tymlos. Then Prolia, but not more than 3 years because otherwise you have to stay on it forever if you go more than 3 years. I'm not sure what happens after the 3 years on Prolia.